Isabella Gallerani

Cicatricial alopecia; a dermatopathologic and immunopathologic study of 33 patients (pseudopelade of brocq is not a specific clinico-pathologic entity)

Abstract

A case of chronic herpes gestationis: persistent disease or conversion to bullous pemphigoid?

We report the case of a 38-year-old woman with herpes gestationis (HG) persistent for 26 months postpartum with typical erythematous-edematous grouped lesions associated with vesicles, blisters, and scaled crusts on most parts of her body. Despite high doses of oral prednisolone, azathioprine, and dapsone, and a trial of 5 plasmaphereses, the disease has persisted to date. Histopathologic examination of lesional skin showed subepidermal blisters, focal basal cell necrosis, and a dermal inflammatory infiltrate including many eosinophils. Direct immunofluorescence showed linear C3 staining in the basement membrane zone and the complement fixation test demonstrated circulating antibasement membrane zone antibodies at a low titer (1:80). HLA typing demonstrated an A2, A24, B35, B52, DR4,5, DR13,15, DRW52,53 phenotype. We present this case as chronic persistent HG and discuss the differential diagnosis between chronic persistent HG and HG evolving to bullous pemphigoid, together with a careful examination of similar cases reported in literature.

Evaluation of inflammatory infiltrate and fibrogenic cytokines in pseudopelade of Brocq suggests the involvement of T‐helper 2 and 3 cytokines

Background  Pseudopelade of Brocq (PB) is an acquired progressive cicatricial alopecia which is characterized by some distinctive clinical features. It may represent either a distinct entity, i.e. an idiopathic primary scarring alopecia, or the end stage of various forms of scarring alopecia such as discoid lupus erythematosus (DLE) or lichen planopilaris (LPP).

A case of angiosarcoma of the face successfully treated with combined chemotherapy and radiotherapy

q 2000 British Association of Dermatologists, British Journal of Dermatology, 142, 812±851 calcification of the subcutaneous cellular tissue and leucocytoclastic vasculitis. We believe that in the present case, the multiple myeloma and the renal failure produced an increase in serum calcium levels which, coupled with the increase of temperature produced by the electric blanket, represented decisive factors in the appearance of the calcification of the skin by precipitation of calcium salts. Local factors such as repeated trauma, needle stick injuries, burn scars and medical studies with saturated calcium chloride electrode paste have been incriminated in the genesis of dystrophic calcinosis, and justify our thinking that local heat could possibly have favoured cutaneous calcinosis in this patient with metastatic, but not dystrophic calcinosis (by previous hypercalcaemia). This could also explain the exceptional fact that the calcification was located at the dermoepidermal junction and remitted in a few months, after normalization of calcaemia.

Familial cutaneous collagenoma: report of an affected family.

A 44‐year‐old white woman was admitted to our hospital for the investigation of many roundish, pale‐colored, nodular lesions of different sizes, ranging from a few millimeters to some centimeters, symmetrically grouped on the shoulders ( Fig. 1 ), trunk, upper limbs, and abdomen. The lesions first appeared at 20 years of age on the upper chest around the clavicular region, and thereafter gradually increased on the trunk and upper limbs; they were completely asymptomatic, appearing on normal skin without a previous history of inflammation and/or trauma. No scarring or atrophy was evident. The smaller lesions exhibited a miliaria‐like shape, being evident in particular on stretching of the skin; the larger ones showed a firm‐elastic density, no adhesion to surrounding tissue, and deep localization in the skin. No hypopigmented macules or sebaceous adenoma‐like lesions were present. Skin biopsy of a nodular lesion from the right shoulder revealed a normal epidermis and a dermis filled with bundles of dense and coarse collagen fibers ( Fig. 2 ). Elastic fibers appeared thin and decreased in number under Verhoeff–van Gieson stain ( Fig. 3 ). A diagnosis of cutaneous collagenoma was proposed. Routine laboratory investigations were within the normal range. Chest and skeleton (hands, pelvis, and long bones) X‐ray, electrocardiogram, and echocardiogram showed no abnormality.

Erythrodermic bullous pemphigoid.

Case 1 An 87‐year‐old man, with a 2‐year history of a generalized exfoliative erythroderma involving approximately 90% of the body, presented with an onset of tense blisters symmetrically distributed on most of his body.

A case of vesiculo-bullous Darier's disease associated with bipolar psychiatric disorder.

We describe the case of a 71‐year‐old men suffering from Dariers disease since his youth and presenting with intensely itching, vesicular and pustular lesions, localized on his arms, legs and on the ulnar side of his right hand. The patient also had a 30 year‐history of bipolar psychiaric disorders. The histopathological examination of lesional skin showed suprabasal acantholytic clefting, hyperparakeratosis, and dyskeratosis. Histopathological and immunopathological (direct and indirect immunofluorescence) results, were consistent with vesiculo‐bullous Dariers disease. Corticosteroid therapy with methylprednisolone at low dosage (0.2 mg/kg/day) was started with a quick resolution of the vesicular lesions on his arms and legs.

Dermatitis herpetiformis and vitiligo: report of a case and review of the literature.

We describe the case of a 53‐year‐old woman presenting papulous and papulovesicular lesions that were highly pruritic, localized mostly in the achromic areas of vitiligo and symmetrically distributed on the elbows, the buttocks, the shoulders and the neck. The histopathological examination performed on the elbows lesional skin showed the presence of neutrophils and fibrin microabscesses at the tips of dermal papillae, with a few eosinophils, and small separations between the dermis and epidermis just over the infiltrate. The overlying epidermis was uninjured. The performed tests detected IgA anti‐endomysium, anti‐thyrogloblin, anti‐smooth muscle and anti‐microsomal fraction autoantibodies; DIF showed the presence of IgA granular deposits at the dermo‐epidermal junction, prevalently at the tips of dermal papillae. This is the tenth case reported of an association between dermatitis herpetiformis and vitiligo. Although the two disorders both have immunological pathogeneses, we think that the topographic coexistence of both disorders is coincidental.